Elsevier

Gastrointestinal Endoscopy

Volume 62, Issue 6, December 2005, Pages 875-883
Gastrointestinal Endoscopy

Original Article
Utilization of colonoscopy in the United States: results from a national consortium

https://doi.org/10.1016/j.gie.2005.06.037Get rights and content

Background

To assess capacity for colonoscopy, we need to understand current utilization of colonoscopy in diverse clinical practice settings. The objective of this study was to determine the utilization of colonoscopy in diverse clinical practice settings.

Methods

The Clinical Outcomes Research Initiative (CORI) data repository, which receives endoscopy reports from 73 diverse adult practice sites in the United States was used. Colonoscopy reports from January 2000 to August 2002 were analyzed to determine the demographic characteristics of adult patients who received a colonoscopy and the procedure indication. The relationship of age, race, gender, and procedure indication was analyzed.

Results

Results of colonoscopies in 146,457 unique patients were analyzed. Of the reports, 68% came from nonacademic settings. Patients less than 50 years of age accounted for 20% of colonoscopies. The most common indications were rectal bleeding (33.6%), irritable bowel symptoms (23.8%), or screening because of a positive family history of colorectal cancer (22.4%) and screening with a primary colonoscopy or a fecal occult blood test (FOBT) (12.8%). In patients 50 years and older, asymptomatic screening (average-risk screening colonoscopy, positive family history, or FOBT positivity) accounted for 38.1% of all colonoscopies. Surveillance colonoscopy in patients with previous cancer or polyps accounted for 21.9% of colonoscopies performed in this age group. Differences in utilization were noted, based on gender and race.

Conclusions

Colonoscopy utilization varies based on age, gender, and race. Colonoscopy often is performed in patients less than 50 years old for irritable bowel symptoms; rectal bleeding; or average-risk screening, for which benefits are uncertain. In patients older than 50 years, surveillance after polyp removal is a common indication and may be overused. Understanding utilization can lead to further study to determine outcomes, to optimize utilization, and to provide a basis for shifting limited resources.

Section snippets

CORI

Practice sites throughout the United States joined the CORI consortium from 1996 to 2001. Participating sites agreed to use a structured, computerized report generator to produce all endoscopic reports and to comply with quality-control requirements. The data file from the report is transmitted electronically to a central data repository, the National Endoscopic Database. All patient and physician identifiers are removed from the data file before transmission from the local site to protect both

Results

We received complete colonoscopy examination reports from 146,457 unique patients during the study period. Reports were received from private practice settings (68%), academic universities (20%), and Veterans Affairs (VA) medical centers (12%).

Discussion

This is the first study to characterize the utilization of colonoscopy in diverse clinical practice settings. Characterization of current endoscopic practice patterns can help inform decisions with regard to resource utilization. Unlike claims databases, the CORI repository provides a wealth of clinical information with regard to patient symptoms and findings. Unlike the Medicare database, the repository reflects the full spectrum of endoscopy across all age groups. Unlike research from

References (29)

  • K.D. Fine et al.

    Comparison of the color of fecal blood with the anatomical location of gastrointestinal bleeding lesions: potential misdiagnosis using only flexible sigmoidoscopy for bright red blood per rectum

    Am J Gastroenterol

    (1999)
  • W.N. Segal et al.

    The outpatient evaluation of hematochezia

    Am J Gastroenterol

    (1998)
  • C.P. Theuer et al.

    Racial and ethnic colorectal cancer patterns affect the cost-effectiveness of colorectal cancer screening the United States

    Gastroenterology

    (2001)
  • M. Pignone et al.

    Screening for colorectal cancer in adults at average risk: a summary of the evidence for the U.S. Preventive Services Task Force

    Ann Intern Med

    (2002)
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    This project was supported with funding from NIDDK UO1 CA 89389-01 and R33-DK61778-01.

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